1. Diabetes and Planning Pregnancy Alison Leyland Diabetes Specialist Midwife Blackpool Teaching Hospitals NHS Foundation Trust June 2012

2. Are you thinking of having a baby? Have you wondered if having diabetes may make a difference to your pregnancy? … then let’s be S.A.F.E.R.

3. S top Think ahead…… A 1c Is your HbA1c (blood glucose) on target or too high? F olic acid How much folic acid should you take? E njoy Enjoy planning your pregnancy and… giving your baby a healthy start R eferral Early referral to specialist care

4. A1c…..is it too high? If your HbA1c is too high 64 mmol/mol (>8%) at the time of conception it may affect your baby’s development or increase your chance of miscarriage. Aim for 43 (<6.1%) provided you are not troubled by hypos. Test your blood sugar frequently Ask your nurse or doctor to refer you to a specialist diabetes preconception team to support you.

5. Folic acid All women with diabetes are recommended to take Folic acid 5mg from 3 months prior to conception This helps prevent Neural Tube Defects (NTD) such as Spina Bifida

6. Medication Many medications are not suitable for the growth and development of your baby e.g. those given for: Blood pressure High cholesterol Some diabetes treatments It is very important to check with your GP prior to trying for a baby as treatment may need to be changed to one more suitable for pregnancy

7. Diabetes complications Before pregnancy it is important to have assessment of your: EyesKidneysHeart

8. Weight Management If you are overweight it is advised to lose weight before pregnancy to increase your chances of becoming pregnant and of having a healthy pregnancy Aim for BMI < 30 This will improve your blood glucose control and reduce the risk of complications in pregnancy

9. Smoking and Alcohol intake Smoking and alcohol can harm your baby You are advised not to smoke or drink alcohol during pregnancy To support you to stop smoking seek advise from your GP

10. Enjoy … preparing for pregnancy Enjoy preparing for pregnancy and giving your baby a healthy start In the mean time it is important to use effective contraception until advised by your specialist team that it is safe for you to become pregnant Your GP or family planning clinic will be able to advise

11. Referral … To help you achieve these things and prepare for a healthy pregnancy you will need the help and support of the specialist diabetes pre-conception team. Ask your GP for a referral Early referral to the Joint Diabetes antenatal clinic once pregnant

12. Thank you